Provider Demographics
NPI:1679079685
Name:PATEL, MADHAV (MD)
Entity type:Individual
Prefix:
First Name:MADHAV
Middle Name:
Last Name:PATEL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EMBARCADERO CTR FL 19
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-3628
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:415-252-7176
Practice Address - Street 1:280 COBB PKWY SE
Practice Address - Street 2:SUITE 60
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1838
Practice Address - Country:US
Practice Address - Phone:678-820-7373
Practice Address - Fax:415-252-7176
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA92026207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program